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A traumatic insult to the brain possibly producing physical, intellectual, emotional, social, and vocational changes
Major Head (brain) Trauma
Ex: Transportationaccidents, Falls, Sports-relatedevent, Violence
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Cause/Effect of Closed (Blunt-Nonmissle) Trauma
- *Head strikes hard surface or a rapidly moving object strikes the head
- *The dura remains intact and brain tissues are not exposed to the environment
- *Causes focal (local) or diffuse (general) brain injuries
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Effects of an Open (pennetrating, missile) Trauma
- *Injury breaks the dura and exposes the cranial contents to the environment
- *Causes primarily focal injuries
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*Injury directly below the point of impact
Coup Injury
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*Injury on the pole opposite the site of impact
Contrecoup
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Types of Brain Trauma
- Coup injury
- Contrecoup
- Compound fractures
- Basilar skull fracture
- Closed (Blunt-Nonmissle)
- Open (pennetrating, missile)
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The force from a Focal Brain Injury can usually cause:
Contusions
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Observable brain lesion
Focal Brain Injury
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Contusions Cause:
- Extradural (epidural) hemorrhages or hematomas
- Subdural hematomas
- Intracerebral hematomas
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Categories of a Diffuse Brain Injury
- Mild concussion
- Classical concussion
- Mild, moderate, and severe diffuse axonal injuries (DAI)
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Temporary axonal disturbance causing attention and memory deficits but no loss of consciousness
Mild Concussion
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Levels/Stages to a Mild Concussion
I: confusion, disorientation, and momentary amnesia
II: momentary confusion and retrograde amnesia
III: confusion with retrograde and anterograde amnesia
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Things that occur with a Classic Cerebral Concussion (GRADE IV)
- *Disconnection of cerebral systems from the brain stem and reticular activating system
- *Physiologic and neurologic dysfunction without substantial anatomic disruption
- *Loss of consciousness (<6 hours)
- *Anterograde and retrograde amnesia
- *Postconcussive syndrome
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Produces a traumatic coma lasting more than 6 hours because of axonal disruption
Diffuse Axonal Injury
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Traumatic injury of vertebral and neural tissues as a result of compressing, pulling, or shearing forces
Spinal Cord Trauma
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How dows Spinal Cord Trauma usually occur?
- From Vertebral Injuries
- (ie: Simple fracture, compressed fracture, and comminuted fracture and dislocation)
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What are the most common locations for a Spinal Cord Injury
- cervical (1, 2, 4-7), and
- T1-L2 lumbar vertebrae
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How do the locations of the vertebrae that is usually injured in Spinal Cord Trauma relate to the injury?
Locations reflect most mobile portions of vertebral column and the locations where the spinal cord occupies most of the vertebral canal
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*Normal activity of the spinal cord ceases at and below the level of injury. Sites lack continuous nervous discharges from the brain.
*Complete loss of reflex function (skeletal, bladder, bowel, sexual function, thermal control, and autonomic control) below level of lesion
Spinal Shock
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*Massive, uncompensated cardiovascular response to stimulation of the sympathetic nervous system
*Stimulation of the sensory receptors below the level of the cord lesion
Autonomic hyperreflexia (dysreflexia)
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Degenerative Disorders of the Spine
- Degenerative disk disease
- (DDD)
Low back pain
Herniated intervertebral disk
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Degenerative Disk Disease *DDD
- -Spondylolysis
- -Spondylolisthesis
- -Spinal stenosis
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Cerebralvascular Disorders
- CVAs (Cerebravascular Accident)
- Intracranial Aneurism
- Subarachnoid Hemmorhage
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Leading cause of Disability, 3rd leading cause of death in the US
CVA
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Arterial occlusions caused by thrombi formed in arteries supplying the brain or in the intracranial vessels
(Transient ischemic attacks (TIAs)
Thrombotic Stroke
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Fragments that break from a thrombus formed outside the brain
Embolic Stroke
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Types of Intracranial Aneurisms
- Saccular (berry) aneurysms
- Fusiform (giant) aneurysms
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What happens when blood escapes from defective or injured vasculature into the subarachnoid space
Subarachnoid Hemorrhage
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What are the manifestations of a Subarachnoid Hemorrhage?
- Kernig sign
- Brudzinski sign
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Infection and Inflammation of the CNS
Meningitis
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Types of Meningitis
- Bacterial meningitis
- Aseptic (viral, nonpurulent, lymphocytic) meningitis
- Fungal meningitis
- Tubercular (TB) meningitis
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Acute febrile illness, usually of viral origin with nervous system involvement
Encephalitis
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What is the most common forms of encephalitis caused by?
Arthropod-borne viruses and herpes simplex virus
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Neurologic Complications of AIDs
- Human immunodeficiency-associated cognitive dysfunction
- HIV myelopathy
- HIV neuropathy
- Aseptic viral meningitis
- Opportunistic infections
- CNS neoplasms
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Progressive, inflammatory, demyelinating disorder of the CNS
MS (Multiple Sclerosis)
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Peripheral N.S. disorders
- ALS
- GB (Guillain-Barre syndrome)
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ALS
"Lou Gehrig disease”
Diffusely affects upper and lower motor neurons of the cerebral cortex, brain stem, and spinal cord (corticospinal tracts and anterior roots)
Disease leads to progressive weakness leading to respiratory failure and death
Patient has normal intellectual and sensory function until death
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Guillain-Barre Syndrome
Acquired inflammatory disease causing demyelination of the peripheral nerves with relative sparing of axons
Acute onset, ascending motor paralysis
Humoral and cellular immunologic reaction
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Neuromuscular Junction Disorders
- MG (Myasthenia Gravis)
- *Chronic autoimmune disease
- *An IgG antibody is produced against acetylcholine receptors (antiacetylcholine receptor antibodies)
- *Weakness and fatigue of muscles of the eyes and the throat causing diplopia, difficulty chewing, talking, swallowing
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Cranial Tumors
- Primary intracerebral tumors (gliomas)
- •Astrocytoma
- •Oligodendroglioma
- •Ependymoma
- Primary extracerebral tumors
- •Meningioma
- •Nerve sheath tumors
- •Metastatic carcinoma
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Spinal Cord Tumors
Intramedullary tumors
- Extramedullary tumors
- •Intradural
- •Extradural
- Manifestations
- •Compressive syndrome
- •Irritative syndrome
- •Syringomyelic syndrome
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